St



St. Luke’s University Hospital

This program is primarily intended for inpatient staff at the Bethlehem Campus although most concepts may apply at any campus within the network.

Pain Scripting, Interventions, & Expectations for the Healthcare Team

Directions for Completion

1. Before proceeding to the posttest, be sure you have read the following pages.

2. Exit this page and complete the posttest which is final step of this education.

← “Take Test” may be a posttest or acknowledgment statement.

← Remember, no attendance record is needed.

← Completion of the posttest will be sent electronically to your EduTracker record once a 100% is achieved.

← Print the Certificate of Completion for your records if desired.

3. Comments, question, or suggestions can be directed to Heather Alban, RN, MS, Clinical Specialist Palliative Care or Nikki Alderfer, Manager, PPHP 9.

The following information was compiled as a quick reminder of key points and strategies to keep in mind when assessing and reassessing a patient’s pain. You can also find this reminder sheet on the Nursing Practice Resource Site.

The purpose of formally reviewing this information is to ensure that all members of the healthcare team are focused on individualizing the patient’s pain management plan to meet his/her needs, expectations, and perceptions.

Patients have expectations around their hospitalization and often that means they expect to be pain free and therefore, pain control is a hot topic in patient satisfaction.

How do you think we score when patients answer the following types of questions?

o How often was your pain well controlled?

o How often did staff do all they could to help you with pain?

These are examples of HCAHPS questions. We do not do so well in this category in the patients’ eyes.

The Individuality of Pain

No one could ever begin to know or judge the pain experience of another individual.

What does it mean to have pain “well controlled”?

▪ Patient satisfaction improves when we do all we can to control the patient’s pain and tell the patient and family what we are doing to keep pain well controlled.

▪ It is not necessary to completely relieve pain to change the patient’s perception.

▪ The pattern of pain relief, not pain severity, may be the critical determinant of satisfaction.

Barriers to pain management

Failure to believe the patient Misconceptions regarding addiction

Inadequate assessment of pain Inadequate knowledge

Low priority given to pain treatment Not understanding a patient’s pain

What does “do all we can” mean to the patient?

▪ It is important to acknowledge that sometimes patients will feel pain.

▪ Ask the patient what “well-controlled” means to him/her. What is tolerable? What is the patient’s pain level goal -- Ask for a number (i.e. a rating of 3? a rating of 5?).

▪ Write the patient’s pain goal number on the white board so all team members are aware.

▪ We need to tailor our care to each patient.

▪ Be proactive with pain management.

▪ Ask the patient about pain during hourly rounding.

Scripting (examples of communication techniques shown to be helpful)

▪ “Mr. Smith, because of your (injury, illness, surgery) you are going to experience pain.  We will not be able to make your pain level a zero, but we do want to do all that we possibly can to keep your pain well controlled and manageable for you.”

▪ “I want to do all that I can to help with your pain and make you as comfortable as possible.”

▪ “Tell me about your pain right now.”

▪ “We are going to do the best job we can to ensure your pain is well controlled and to manage your pain as safely as possible.”

▪ “There may be some discomfort inherent with your condition, however we want to make you as comfortable as possible.”

▪ “We will do all we can to keep your pain well controlled and manageable for you.”

▪ “When you are at home, how do you get comfortable?”

▪ “Let’s try a new position that may alleviate your pain a bit.”

▪ “Last time you needed 6 mg of medication after 6 hours. Now you need only 3 mg for 6 hours. We are making progress in helping to control your pain.”

Non-Pharmacologic Interventions

▪ Ask the patient, “In the past, what has helped you keep your pain well controlled?” or “We would like to take your preferences into account, can you tell me what has worked for you regarding pain control?”

▪ Acknowledge actions you are already undertaking to impact the level of pain.

▪ Examples of non-pharmacologic interventions to control pain:

Repositioning Distraction Music

Appropriate use of humor Massage Imagery

Ask about pain in hourly rounds Use of heat or cold Breathing techniques

Temperature of room Relaxation Appropriate use of body mechanics

All staff members are responsible to address patients’ pain needs and to use non-pharmacologic pain management interventions as able based on role/position.

Points to Remember:

o Write the patient’s pain goal on the white board. Update it throughout the day as it may change.

o Refer to the patient’s pain goal every time you are in the room.

o Use scripting – connecting the dots for the patient (i.e. relating the intervention you are doing back to the patient’s pain)

o Contact Heather Alban or other appropriate pain service as a nursing measure to assist with suggestions for the patient’s pain management plan.

o Talk about a patient’s pain issues in Care Coordination rounds to ensure they get addressed.

o Look for information on your unit regarding how well your unit is doing in the patients’ eyes…

HCAHPS scores go higher when the patient is able to answer “Always” to the pain control questions on their survey. When that happens, it means we are doing a good job!

Close & “Take Test”

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